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Opioid-related deaths among children, teens and young adults under age 20 have nearly tripled nationally since 1999, a recent study shows.

A team of Yale University researchers analyzed mortality data from the Centers for Disease Control and Prevention and found that 8,986 children and adolescents ranging in age from birth to 19 years old died from opioid poisoning in the United States between 1999 and 2016 in what the researchers referred to as an epidemic of abuse.

The study, published Dec. 28 in the Journal of the American Medical Association, showed that 73 percent of the deaths were male and 88 percent involved children ages 15 to 19 years old. Children younger than 5 accounted for 607 — nearly 7 percent — of the deaths.

Among adolescents ages 15 to 19, heroin was involved in 1,872 deaths, and 3,050 deaths involved one or more prescription or illicit substances in addition to an opioid, including benzodiazepines, cocaine, alcohol, antidepressants and cannabis.

An overwhelming portion of the deaths, 80 percent, were ruled unintentional, while about 5 percent — or 445 deaths — were attributed to suicide, which the study says doubled in frequency among children and adolescents during the same time period. A small portion, 2.4 percent, of the deaths were considered homicides.

“What began more than two decades ago as a public health problem primarily among young and middle-aged white males is now an epidemic of prescription and illicit opioid abuse that is taking a toll on all segments of U.S. society, including the pediatric population,” the researchers wrote.

In Iowa, however, the number of children and adolescents dying of opioid poisoning is minuscule, said Kevin Gabbert, opioid initiatives director for the Iowa Department of Public Health.

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“In Iowa, when it comes opioid-related deaths involving individuals who are 18 and under, there are fewer than our reportable threshold, which means fewer than six,” he said.

And locally, Cedar Rapids Police Sgt. Robert Collins said a quick search of department records showed no underage overdoses.

“But that doesn’t mean they didn’t happen,” he said. “If they did, they just might not have been reported.”

Collins said a majority of the opioid overdoses he’s seen — fatal or not — involved individuals who had long-established drug histories, something not typically associated with children or adolescents.

In talking with overdose survivors, Collins said he typically asks them to trace their entire addiction history. Those histories, he said, often trace back to childhood or adolescence when they started smoking cigarettes or sneaking alcohol from their parents’ liquor cabinet.

“And, by the time they’ve gotten to the point where they are shooting heroin or abusing opioids, they already have this mind-set where using something to feel good or feel better is acceptable, so that when the pills or the hard drugs came out, that was acceptable, too,” he said.

Opioids in Iowa

The total number of opioid-related deaths in Iowa for 2017 was 206, Gabbert said, and the data so far for 2018 shows a possible drop in deaths, with the preliminary total at 126. That number, he said, “is going to change” as state and county medical examiners finish filing their year-end reports.

On the other hand, opioid-related treatment admissions in Iowa steadily increased between 2005 and 2015, Gabbert said. But in 2016 and 2017, the state saw slight decreases.

In 2005, Gabbert said 652 people admitted to treatment facilities listed opioids as the primary drug of choice. By 2015, the number of opioid-related admissions jumped to more than 2,500.

The numbers have dropped slightly since then, with 2,274 opioid-related admissions in 2016 and 2,244 in 2017.

Those numbers, he said, refer to opioid-related admissions for adults and minors.

For opioid-related treatment admissions for people under 18, Gabbert said the numbers fluctuate year to year.

In 2014, 25 minors admitted to treatment facilities listed opioids at the primary drug of choice. The following year, there were 26 admissions, and the next year that number inched up to 28. In 2017 there was a significant drop with 15 admissions, and 2018 could shape up to be another low year with preliminary data showing nine admissions.

Gabbert, however, cautioned that 2018 data is not yet complete and the numbers are expected to change.

Juvenile arrests

As for arrests, Sgt. Collins said Cedar Rapids police have made 69 drug-related arrests involving juveniles since 2014. Of those, 27 were charged with heroin possession. The other arrests, he said, involved prescription pills, which could have included prescription opioids.

In 2014, there were nine juveniles arrests and four in 2015, Collins said — none involving heroin. 2016 was a bit of an anomaly, Collins said, when drug-related arrests of juveniles jumped to 31, with 18 involving heroin-related charges. The numbers dropped the following year, with 15 arrests in 2017 — six of which involved heroin — and 10 arrests in 2018, with three involving heroin.

According to the study, much or all of past research examining heroin and opioid overdose trends focus on adults, making little to no mention of children and adolescents. In not looking at the risks younger generations face, state and federal preventive measures are incomplete, the study said.

“The underrecognition of the risks that prescription and illicit opioids pose to children and adolescents is reflected in the current policies and practices in place in the United States today,” the researchers wrote. “Of the hundreds of state and federal initiatives enacted to contain the opioid crisis, nearly all focus on adults.”

The study concluded that action specific to children and adolescents is needed to stem the overdose death rates in those age groups.

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“(Our) findings suggest that the opioid epidemic is likely to remain a growing public health problem in the young, unless legislators, public health officials, clinicians and parents take a wider view of the opioid crisis and implement protective measures that are pediatric specific and family centers,” the researchers wrote.